Challenging Depression Criteria: An Exploration of Men's Experiences of Depression.

Abstract

This dissertation investigates the disparity between men and women in the prevalence of depression. Published data consistently reports that women are affected by depression at approximately twice the rate of men. Literature suggests that this difference may occur because current measures underdetect depression in men. Underdetection occurs for two reasons: men may be underreporting symptoms of depression and men may exhibit alternative symptoms of depression that are not included in the current diagnostic criteria. This research uses data from the Collaborative Psychiatric Epidemiology Surveys (CPES), to create three new measures of depression. Chapter Three describes Irritable Depression (ID), which is similar to Major Depressive Disorder, substituting irritability for dysphoria. ID is not a prevalent condition, and as with MDD, was more prevalent in women (6.5%) than men (5.0%). Adding irritability to the depression criteria had no effect on reducing the sex ratio of depression. Chapter Four assessed depression using two newly constructed measures, the Male Symptoms Scale (MSS) and the Gender Inclusive Depression Scale (GIDS). The MSS included "male-type" symptoms of depression that were identified through extensive literature review. The second scale, the GIDS, included these symptoms as well as the more conventional (i.e., DSM) depression symptoms. Men reported higher rates of anger attacks/aggression, substance use, and risk-taking as compared to women, in both the MSS and AMDS analyses. These findings suggest that depressed men exhibit anger and cope with their depression through destructive outlets. The MSS identified depression in a significantly higher proportion in men (26.3%) than women (21.9%), (F/M: 0.83, p<.01). The GIDS found that men and women met case criteria for depression in equal proportions, 30.6% of men and 33.5 of women, (F:M 1.09, NS). These findings suggest that when the alternative and traditional symptoms are combined, the prevalence of depression becomes equalized across the sexes. Clearly, if the criteria are expanded more men will be diagnosed. This raises serious questions about the validity of existing depression criteria and warrants a re-examination of how we classify depression cases, with particular attention needed to address depression in men.